Heart Remodeling and Change of General Hemodynamics in Adolescents with Arterial Hypertension

L.F. Bogmat, V.V. Nikonovа

Abstract

The purpose of this research — the study of the features of cardiac remodeling and changes in general hemodynamics in adolescents with arterial hypertension (AH), depending on body weight.Materials and methods. A comprehensive survey of 102 young men 13–18 years old with hypertension, including 32 teenagers with hypertension and normal weight, 23 — with hypertension and overweight and 47 — with hypertension and obesity I–II degree. Physical development of children was evaluated using anthropometric parameters and calculation of body mass index (BMI, kg/m2). BMI was assessed by nomograms based on age and gender. BMI was considered normal, which is between 15th and 85th percentile. BMI between 85th and 97th percentile were regarded as excess body weight, and above 97th percentile — as obesity. The criterion for abdominal obesity was considered waist waist circumference (WC), and even more 94 cm for males over 16 years, and more than the 90th percentile for children up to 15 years (IDF 2007). Functional state of the cardiovascular system is studied by echocardiography in the M and B modes using 3.5 MHz probe on the unit Sonoline-SL1, the company Siemens by the standard method, which is recommended by the Association of Echocardiography.Results and discussion. Thу one anthropometric indicator of adolescents selected groups by which they did not differ from each other was growth. Mean of body mass index in patients with hypertension and overweight and obesity and hypertension ranged from 26.55 ± 0.35 kg/m2 to 31.98 ± 0.67 kg/m2, in contrast to patients with hypertension and normal body weight, in which this figure was at 22.21 ± 0.35 kg/m2 (p < 0.001). A statistically significant difference between the average of the index WC/HC in patients with hypertension and obesity in patients with hypertension and overweight (p < 0.001). The increase of WC more than 94 cm for boys aged 16 years and over the 90th percentile for children under 15 years old, found in 20.0 ± 7.7 % of cases only among young men with hypertension and obesity, WC they ranged from 93 up to 128 cm. In assessing cardiac parameters set features: a group of young men with AH and obesity, compared with the control group, there was an increase in the diameter of the aortic root (p < 0.05), the expansion of the left atrium (p < 0.05), dilatation of the left ventricular cavity (p < 0.05). The rear wall of the left ventricle (P < 0.01) and septum (p < 0.01) were also significantly thicker, resulting in an increase of myocardial mass (p < 0.05) and an increase in the relative thickness of the wall of the left ventricle (p < 0.05). In the group of adolescents with AH and overweight reported thickening of posterior wall of left ventricle (p < 0.01) and interventricular septum thickness (p < 0.01), resulting in an increase in LVMI (p < 0.1), the relative growth left ventricular wall thickness (p < 0.01) and an increase in the diameter of the root of the aorta (p < 0.05). Noteworthy expansion of the cavity of the right ventricle, as a group of overweight and obesity in boys (p < 0.01, p < 0.01, respectively).In the group of adolescents with AH and normal body weight cardiac parameters did not reach the level of confidence compared with the control group. When an individual assessment of cardiac parameters revealed that concentric left ventricular hypertrophy was recorded in 1 (3.13 %) teen with hypertension and normal body weight, 4 (17.39 %) of young men with hypertension and overweight, and 7 (14.89 %) with hypertension and obesity. Eccentric left ventricular hypertrophy was detected in 3 (13.04 %) patients with AH and overweight, and 11 (23.40 %) with hypertension by obesity. Left ventricular cavity dilatation was diagnosed in 9 (28.12 %) patients with hypertension and normal weight, 14 (60.88 %) — with hypertension and overweight, and 22 (46.80 %) of young men with hypertension against obesity. Thus, in adolescents with AH and overweight mass index biventricular heart remodeling occurs predominantly concentric myocardial hypertrophy of the left ventricle, unlike adolescents with AH and obesity, where cardiac remodeling occurs with the formation of eccentric hypertrophy, mainly due to the interventricular septum. Noteworthy is the formation of the two groups of adolescents (overweight and obesity) signs of diastolic dysfunction of the left ventricular myocardium and significant dilatation of the aortic root.